Prevalence of Psychotropic Medicine Use in Australian Children with Autism Spectrum Disorder: A Drug Utilization Study Based on Children Enrolled in the Longitudinal Study of Australian Children

Patterns of Psychotropic Prescribing Practices in Autistic Children and Adolescents: An Australian Perspective of Two Cohorts Five Years Apart

This study aims to describe the utilisation of psychotropic medications in Australian autistic children and adolescents. All children and adolescents with available Pharmaceutical Benefits Scheme data who endorsed an autism diagnosis in The Longitudinal Study of Australian Children, including both B (n = 233, age 0-1 years in wave 1) and K cohorts (n = 157, age 4-5 years in wave 1), were included to describe psychotropic prescribing patterns. 212 (54.4%) autistic children and adolescents received at least one psychotropic prescription and 99 (25.4%) had polypharmacy. The most common psychotropic class prescribed was antidepressants (31.3%). Children in the B cohort were more likely to have a parent-reported diagnosis of anxiety or depression (χ2 = 12.18, p < 0.001) and tended to be more likely to have received a psychotropic prescription (χ2 = 3.54, p = 0.06). Psychotropic prescribing in Australian autistic children is common despite limited evidence for efficacy and tolerability of psychotropics in this group.

Mice with an autism-associated R451C mutation in neuroligin-3 show intact attention orienting but atypical responses to methylphenidate and atomoxetine in the mouse-Posner task

RATIONALE

Atypical attention orienting has been associated with some autistic symptoms, but the neural mechanisms remain unclear. The human Posner task, a classic attention orienting paradigm, was recently adapted for use with mice, supporting the investigation of the neurobiological underpinnings of atypical attention orienting in preclinical mouse models.

OBJECTIVE

The current study tested mice expressing the autism-associated R451C gene mutation in neuroligin-3 (NL3) on the mouse-Posner (mPosner) task.

METHODS

NL3R451C and wild-type (WT) mice were trained to respond to a validly or invalidly cued target on a touchscreen. The cue was a peripheral non-predictive flash in the exogenous task and a central spatially predictive image in the endogenous task. The effects of dopaminergic- and noradrenergic-modulating drugs, methylphenidate and atomoxetine, on task performance were assessed.

RESULTS

In both tasks, mice were quicker and more accurate in the validly versus invalidly cued trials, consistent with results in the human Posner task. NL3R451C and WT mice showed similar response times and accuracy but responded differently when treated with methylphenidate and atomoxetine. Methylphenidate impaired exogenous attention disengagement in NL3R451C mice but did not significantly affect WT mice. Atomoxetine impaired endogenous orienting in WT mice but did not significantly affect NL3R451C mice.

CONCLUSIONS

NL3R451C mice demonstrated intact attention orienting but altered responses to the pharmacological manipulation of the dopaminergic and noradrenergic networks. These findings expand our understanding of the NL3R451C mutation by suggesting that this mutation may lead to selective alterations in attentional processes.

The use of psychotropic medications in autistic individuals (21 years and younger) in Western Australia: A preliminary investigation

LAY ABSTRACT

Prescriptions and use of medications to treat mental health conditions in young autistic populations are inconsistent worldwide. This makes it hard to compare findings from international studies to the Australian autistic population, where there are limited relevant studies. Apart from risperidone, there are no other medications specified for direct use in autistic persons. This study aims to gain initial broad understanding of the use of medications, commonly prescribed for mental health conditions, specifically by autistics under the age of 21 years. We analysed data that were previously collected as part of the Western Australian Autism Biological Registry between 2011 and 2015 which amounted to 239 surveys completed on young persons with diagnosed autism. The questionnaires included information on co-occurring conditions, current or previous use of medications and reasons for use of the medications. Only one-quarter of the participants in this study reported using at least one mental health-related medication in their lifetime. The most reported medications were stimulants, antidepressants and antiepileptics. The reasons for using medication included managing attention deficit hyperactivity disorder, challenging behaviours, seizures, sleep difficulties and symptoms of anxiety and depression. The number of individuals reporting medication use in this study was lower compared to other developed countries. Nevertheless, these medications should be monitored due to limited understanding of their use to manage co-occurring symptoms in young autistic persons. The findings highlight the importance of ongoing research to better understand mental health-related medications and inform best practice.

Understanding the Diversity of Pharmacotherapeutic Management of ADHD With Co-occurring Autism: An Australian Cross-Sectional Survey

OBJECTIVES

Attention deficit hyperactivity disorder (ADHD) frequently co-occurs with other neurodevelopmental diagnoses, such as autism spectrum disorder (autism), which can make clinical decision making around symptom management challenging for clinicians. There is a paucity of research examining pharmacotherapeutic management of children who have ADHD with co-occurring diagnoses. We aimed to report on the co-occurring diagnoses and symptom profile of children, and report on medication use, stratified by ADHD, autism and ADHD + autism diagnoses.

METHODS AND MATERIALS

Caregivers of 505 children (2-18 years) with ADHD (n = 239), autism (n = 117), and co-occurring ADHD + autism (n = 149) completed a questionnaire on current medication use and clinical rating scales about their child's symptoms, as part of a broader project investigating diagnosis and management of symptoms in children with ADHD or autism.

RESULTS

The parents of the ADHD group reported a higher proportion of their children had learning disorders (17.15%) and speech and language disorders (4.60%) compared to the parents of the autism and ADHD + autism groups. Parents of the ADHD + autism group reported higher proportions of intellectual disability (5.37%), oppositional defiant disorder (20.13%), anxiety (38.93%), depression (6.71%) and genetic conditions (3.36%) in their children, in comparison to the parents of the ADHD and autism groups. Children with ADHD were reported to be taking a higher proportion of psychotropic medication (90%), followed by ADHD + autism (86%) and autism (39%). The parents of children with ADHD + autism reported a higher proportion of non-stimulant ADHD medication (25.5%), antipsychotic (18.79%), antidepressant (22.15%) and melatonin (31.54%) use by their children, compared to the parents of the ADHD and autism groups.

CONCLUSIONS

A similar proportion of children with ADHD + autism and ADHD were reported to be taking medication. However, the types of medication taken were different, as expected with reported co-occurring diagnoses. The complexity of symptoms and diagnoses in ADHD + autism warrants targeted research to optimize management and therapeutic outcomes.

The efficacy and safety in attention deficit hyperactivity disorder of second-generation antipsychotics and other medications for hyperactivity in children and adolescents with autism: a meta-analysis

Children and adolescents with ASD also have co-occurrence of attention deficit hyperactivity disorder (ADHD) symptoms. ADHD symptoms, especially hyperactivity, greatly increased the severity of autism symptoms. This study concentrated on two widely-used medications: the second generation of antipsychotics (SGAs) and ADHD medication, aiming to conduct a meta-analysis about their effect on hyperactivity, so it would offer some evidence for clinical medication choice. The Medline, Embase, Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure databases were searched from inception to July 2019 for studies exploring the use of SGAs and ADHD medications in autistic children and adolescents. Double-blind, randomized controlled trials that reported hyperactivity as an outcome were included in the study. A total of thirteen trials with 712 participants were included in our meta-analysis. For SGAs, the standardized mean difference (SMD) of hyperactivity subscale in Aberrant behavior checklist scale or conners rating scales was 0.59, 95% confidence interval (CI): 0.23-0.96, I2 = 74%, Q = 15.34, P < 0.01. For ADHD medications, SMD was -0.66, with 95% CI: -0.99 to 0.33, I2 = 53%, Q = 15.02, P = 0.04. As for adverse events, in the SGAs group, somnolence had the largest effect size, risk ratio = 5.62, 95% CI: 3.20- 9.87 (I2 = 0%, Q = 2.45, P = 0.65). In ADHD group, the side effect of decreased appetite showed the largest effect size (risk ratio = 2.63, 95% CI = 0.99-7.01, I2 = 65.7%, Q = 11.66, P = 0.02). Both ADHD medications and SGAs were effective in dealing with hyperactivity in children and adolescents with autism but were shown to increase the risk of decreased appetite, somnolence, headache and nausea or vomiting. The clinical use of these medications should carefully weigh the benefits and risks.

Does Awareness of either Psychotropic Medication or Behavioral Interventions Bias College Students' Ratings of a Child's Behavior?

Caregiver awareness that a child receives either psychotropic medication or behavioral intervention could bias that caregiver's perception of the child's behavior and give rise to incorrect conclusions about intervention effectiveness. To evaluate bias for the effects of either medication or behavioral intervention, we randomly assigned 114 participants to one of the four groups: Medication information (Med info), Behavioral information (Beh info), No change (control group), and Reverse video (Rev Vid; also no change, but participants watched videos in the reverse order). Participants watched two 5-min video clips of a child engaging in low to moderate levels of problem behavior. After watching the first video, participants rated the child's problem behavior. Before viewing the second video, participants were informed that (a) the child received medication (Med info group), (b) the child received behavioral intervention (Beh info group), or (c) no treatment changes were made (No change groups). Results show that providing treatment information did not bias participants' ratings of the child's behavior. Instead, results indicate participants in the control groups correctly tracked actual changes in the child's behavior.

Environmental Methamphetamine Exposures and Health Effects in 25 Case Studies

The clandestine manufacture and use of methamphetamine can result in contamination of residential properties. It is understood that this contamination remains in homes for a significant period, however there are a lack of data available to understand the health effects of exposure to environmental methamphetamine contamination (third-hand exposure). Our study collected information from 63 individuals in 25 separate case studies where the subjects had unwittingly suffered third-hand exposure to methamphetamine from former manufacture, use, or both. Data included environmental contamination data, information on subjects' health effects, and evidence of exposure using hair analysis. This study identified a range of health effects that occur from residing in these properties, including behavioural effects or issues, sleep issues, respiratory effects, skin and eye effects, and headaches. Methamphetamine was detected in hair samples from some individuals, including children. The exposures and concomitant reported health effects covered a wide range of environmental methamphetamine levels in the properties, including low levels close to the current Australian guideline of 0.5 µg methamphetamine/100 cm². There were no discernible differences between health effects from living in properties contaminated from former manufacture or use. This study demonstrates that residing in these properties can represent a serious public health risk.